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close this bookPrinciples of Disaster Mitigation in Health Facilities (PAHO-OPS, 2000, 127 p.)
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View the documentAcknowledgements
View the documentPreface
View the documentIntroduction
View the documentExecutive Summary
Open this folder and view contentsChapter 1 - Disaster and Hospitals
Open this folder and view contentsChapter 2 - Structural Vulnerability
Open this folder and view contentsChapter 3 - Nonstructural Vulnerability
Open this folder and view contentsChapter 4 - Administrative and Organizational Vulnerability
Open this folder and view contentsAnnex* - Methods for the Analysis of Structural Vulnerability
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The planning, design and construction of health facilities in high-risk areas provide multiple challenges to the professionals involved in these efforts, given the importance of such buildings to the every-day life of a city - particularly when disaster strikes. A community’s recovery after a major event depends to a significant extent on the ability of health facilities to function without interruption and to provide the extra care needed during an emergency. Many issues must be considered, ranging from the site chosen for construction to the installation of nonstructural equipment, not to mention the architectural design and structural integrity of the buildings.

Many health facilities have suffered severe damage as a result of natural disasters (particularly high-intensity earthquakes and hurricanes), leading to the partial or total collapse of the structures and the interruption of the health services urgently needed by the victims of the event.

It is in this context that existing regulations on the design and construction of health facilities must be revised. They must be reoriented towards disaster mitigation, with the ultimate goal, not only of protecting the lives of their occupants, but of ensuring that these facilities can continue to function after a disaster strikes.

This book compiles information previously published by PAHO/WHO, covering topics related to potential problems generated by natural events as well as the mitigation measures necessary to ensure that a facility will continue to function during and immediately following an event. It aims to encourage the reader to reflect on the planning, design, construction, operational and maintenance criteria governing health infrastructure. It presents techniques for the identification and assessment of hospital vulnerability. Risk mitigation solutions are presented that will protect both the population and the investments made in building or improving health facilities. The book is not intended to cover in detail technical aspects that have been the subject of academic publications, although the necessary references are included for the benefit of the reader who wishes to study these topics more in depth.

Chapter 1 reviews cases of health facilities affected by disasters in the Americas, including descriptions of the types of damage and, more generally, the losses suffered by health facilities as a result of earth-quakes in recent years. Other topics include the role of health facilities in disaster situations, the demand for their services in such situations, and the economic and social costs of not having access to them at such a critical moment. Finally, the types of physical vulnerability found in health facilities are enumerated.

Chapter 2 focuses on structural vulnerability. When vulnerability is high, the essential operations of a health facility may be compromised, lives may be lost, and the facility’s assets may be destroyed. The chapter discusses architectural practices that augment structural vulnerability, and provides guidelines on how to perform a vulnerability assessment based on the most widely accepted engineering methods. Additional guidelines explain how the facility’s infrastructure can be reinforced through retrofitting or rehabilitation.

The vulnerability of nonstructural elements is the subject of Chapter 3, which discusses the behavior of architectural finishes and of medical and support equipment and installations. Steps are outlined for inventorying and assessing nonstructural vulnerability and carrying out the interventions needed for risk mitigation.

Chapter 4 deals with administrative and organizational vulnerability issues that can interrupt or degrade hospital services after a major event. Key concepts are outlined, including sectoral modernization, decentralization and quality control. These concepts provide the framework for the implementation of sectoral guidelines for disaster mitigation. The wrong administrative and organizational procedures can increase this type of vulnerability; recommendations are made on how to prevent or modify them.

One of the most important topics in this chapter is how to use the various vulnerability assessments of the facilities to perfect disaster preparedness activities until the resources are in place for an intervention. However, the connection between disaster preparedness, on the one hand, and functional and nonstructural aspects on the other, can only be explored here superficially, and readers are encouraged to consult the specialized publications produced by PAHO that are included in the references1, and which detail the methodologies required to formulate, test and update hospital emergency plans.

1 An extensive bibliography on safer hospitals, including relevant publications on hospitals and disaster preparedness, can be found in Bibliodes # 22, September 1995. Bibliodes is published by the Regional Disaster Information Center (CRID), a resource center for disaster mitigation for Latin America and the Caribbean that is partly sponsored by PAHO/WHO and the Secretariat of the International Decade for Natural Disaster Reduction (IDNDR).

The annex outlines current methods used to analyze the structural vulnerability of hospitals.